Background and Purpose:Evidence regarding sex differences in clinical outcomes and treatment effect following intracerebral hemorrhage is limited. Using the ATACH-2 trial (Antihypertensive Treatment in Intracerebral Hemorrhage-2) data, we explored whether sex disparities exist in outcomes and response to intensive blood pressure (BP)–lowering therapy.Methods:Eligible intracerebral hemorrhage subjects were randomly assigned to intensive (target systolic BP, 110–139 mm Hg) or standard (140–179 mm Hg) BP-lowering therapy within 4.5 hours after onset. Relative risk of death or disability corresponding to the modified Rankin Scale score of 4 to 6 was calculated, and interaction between sex and treatment was explored.Results:In total, 380 women and 620 men were included. Women were older, more prescribed antihypertensive drugs before onset, and had more lobar intracerebral hemorrhage than men. Hematoma expansion was observed less in women. After multivariable adjustment, the relative risk of death or disability in women was 1.19 (95% CI, 1.02–1.37, P=0.023). The relative risk of death or disability between intensive versus standard BP-lowering therapy was 0.91 (95% CI, 0.74–1.13) in women versus 1.13 (95% CI, 0.92–1.39) in men (P for interaction=0.11), with inconclusive Gail-Simmon test (P=0.16).Conclusions:Women had a higher risk of death or disability following intracerebral hemorrhage. The benefit of intensive BP-lowering therapy in women is inconclusive, consistent with the overall results of ATACH-2.Registration:URL: https://www.clinicaltrials.gov. Unique identifier: NCT01176565.

中文翻译：

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脑出血后降血压治疗和结果的性别差异：来自 ATACH-2 的结果。

背景和目的：关于脑出血后临床结果和治疗效果的性别差异的证据有限。使用 ATACH-2 试验（脑出血抗高血压治疗 2）数据，我们探讨了结果和对强化降压 (BP) 治疗的反应是否存在性别差异。方法：符合条件的脑出血受试者被随机分配到强化（在发病后 4.5 小时内进行目标收缩压，110-139 mm Hg）或标准（140-179 mm Hg）降压治疗。计算与改良Rankin量表评分4～6分对应的死亡或残疾相对风险，并探讨性别与治疗之间的相互作用。结果：共纳入380名女性和620名男性。女性年龄较大，在发病前服用的降压药较多，并且比男性有更多的脑叶出血。在女性中观察到的血肿扩大较少。多变量调整后，女性死亡或残疾的相对风险为 1.19 (95% CI, 1.02–1.37,P = 0.023)。强化与标准降压治疗之间死亡或残疾的相对风险在女性中为 0.91（95% CI，0.74-1.13），在男性中为 1.13（95% CI，0.92-1.39）（交互作用P =0.11）， Gail-Simmon 检验不确定（P = 0.16）。结论：女性脑出血后死亡或残疾的风险较高。强化降压治疗对女性的益处尚无定论，与 ATACH-2.Registration:URL: https://www.clinicaltrials.gov 的总体结果一致。唯一标识符：NCT01176565。